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General NPI Number Information
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NPI Number | 1639560501
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Entity Type | Organization
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Legal Business Name | MEDIPACE BEVERLY HILLS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 50 N LA CIENEGA BLVD SUITE 310
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2227
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Country | US
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Telephone | 310-550-6240
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Fax | 310-289-0142
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Provider Business Mailing Address
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Address Line | 50 N LA CIENEGA BLVD SUITE 310
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2227
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Country | US
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Telephone | 310-550-6240
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Fax | 310-289-0142
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Authorized Official
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Title or Position | OWNER
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Name | VICTOR GURA
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Credential | MD
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Telephone | 310-550-6240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A34872
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License Number State | CA
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